Isoimmunization Is Unlikely to Be the Cause of Hemolysis in ABO-Incompatible but Direct Antiglobulin Test-Negative Neonates

Herschel, Marguerite; Karrison, Theodore; Wen, Min; Caldarelli, Leslie; Baron, Beverly W.

doi:10.1542/peds.110.1.127

Cited by 47 publications

(17 citation statements)

References 12 publications

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“…The negative predictive value is likely to be high (based on the assumption that there were four false‐negative DATs), which concurs with the findings of Herschel et al. who concluded that isoimmunization is unlikely to be the cause of hyperbilirubinaemia in ABO‐incompatible DAT‐negative newborns and other aetiologies should be sought 20 …”

Section: Discussionsupporting

confidence: 83%

Review of positive direct antiglobulin tests found on cord blood sampling

Dinesh¹

2005

J Paediatrics Child Health

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The positive predictive value of a positive DAT for HDN is 23%. The sensitivity was estimated to be 86%. Ten babies required readmission for phototherapy, two of these were DAT-positive. Jaundice, rather than the positive DAT, was the first alert in the majority of cases of HDN requiring phototherapy. Recommendations for testing are discussed but remain controversial in practice. Assessment for hyperbilirubinaemia in all infants early in life is fundamental.

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Section: Discussionsupporting

confidence: 83%

Review of positive direct antiglobulin tests found on cord blood sampling

Dinesh¹

2005

J Paediatrics Child Health

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“…However, this apparent decline may be spurious, because national trends toward early discharge after delivery may have led to fewer cases of physiological jaundice being diagnosed before discharge, since serum bilirubin levels in full‐term infants do not peak until 48–72 h after birth 15–19 . This hypothesis is supported by study results showing that newborns discharged <72 h after birth have an increased risk for readmission for hyperbilirubinaemia, 20–22 and by others showing that clinically apparent hyperbilirubinaemia is the most common reason for hospital readmission in the neonatal period 22–26 . Similarly, declines in rates of jaundice attributed to blood group (ABO) incompatibility may also be due to the decrease in the average length of hospital stay among full‐term newborns.…”

Section: Discussionmentioning

confidence: 94%

A comparison of morbidity rates attributable to conditions originating in the perinatal period among newborns discharged from United States hospitals, 1989–90 and 1999–2000

Tomashek

Crouse

Iyasu

et al. 2006

Paediatric Perinatal Epid

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Perinatal conditions account for 60% of US neonatal deaths, yet little is known about rates of morbidity attributable to these conditions. To estimate these rates, we analysed newborn hospital discharges from the National Hospital Discharge Survey. We used International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM) codes to classify discharge diagnoses among a weighted, nationally representative sample of newborns discharged from short-stay, non-federal US hospitals. We compared overall and cause-specific morbidity rates attributable to perinatal conditions (ICD-9-CM 760.0-779.9), as well as the average length of hospital stay among newborn discharges during 1989-90 and 1999-2000. The overall newborn morbidity rate declined from 36.3% in 1989-90 to 33.7% in 1999-2000 (P < 0.01), despite significant increases in high-risk births. The decline can be attributed to significant decreases in the reported rates of jaundice, fetal distress, birth trauma and birth asphyxia. Rates of jaundice decreased from 15.7% to 13.4% (P < 0.01). The average length of stay decreased among newborns with no morbid condition (2.37-2.04 days, P < 0.001) and among those with one perinatal condition (3.11-2.51, P < 0.001), but increased among those with multiple perinatal conditions (8.43-9.98, P < 0.05). Morbidity rates among newborns discharged from US hospitals declined. Shorter newborn hospital stays may have resulted in fewer cases of jaundice being diagnosed before discharge. Stricter diagnostic criteria and changes in obstetric practices may have led to a decline in the rates of fetal distress, birth trauma and birth asphyxia.

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“…When abundant spherocytes are observed on the smear of a neonate who has severe jaundice, two main entities should be considered; ABO hemolytic disease and hereditary spherocytosis (HS). Although the DAT is generally positive in the former and negative in the latter, there may rarely be a jaundiced neonate with ABO hemolytic disease with a negative Coombs test, because of insufficient maternal antibody to render the Coombs test positive but still sufficient to result in some degree of hemolysis [16]. Also, the DAT is sometimes negative but the indirect Coombs is positive.…”

Section: Microspherocytesmentioning

confidence: 99%

Neonatal Hemolytic Jaundice: Morphologic Features of Erythrocytes That Will Help You Diagnose the Underlying Condition

2014

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Background: Many cases of severe neonatal hyperbilirubinemia never have the underlying cause of the jaundice clearly identified. Thus they are said to have ‘idiopathic' severe neonatal jaundice. However, finding the exact cause, if it is a genetic condition, can enable informed anticipatory guidance regarding future episodes of hemolysis, anemia, or bilirubin cholelithiasis. Objective: ‘Next generation' gene sequencing can often reveal the mutations responsible for severe neonatal hyperbilirubinemia, but wisely using this new technology involves selective application, employing this testing only if inexpensive technology fails to reveal the diagnosis. Methods: In this review, we display and discuss five types of red blood cell morphological abnormalities that have helped us categorize cases of neonatal hemolytic jaundice. Results: As an aid to applying inexpensive technology, we review morphological abnormalities of erythrocytes that are easily identified on a blood film. When found, these abnormalities can be important clues to the underlying hemolytic condition giving rise to neonatal jaundice. Conclusions: Applying these simple and inexpensive methods can assist neonatologists in caring for neonates who have hemolytic jaundice. We predict that by using these principles the term ‘idiopathic' neonatal jaundice will become less common as the underlying causes are identified.

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Isoimmunization Is Unlikely to Be the Cause of Hemolysis in ABO-Incompatible but Direct Antiglobulin Test-Negative Neonates

Abstract: In DAT-negative newborns with significant jaundice or increased bilirubin production, even if ABO-incompatible, a cause other than isoimmunization should be sought.

Cited by 47 publications

References 12 publications

Review of positive direct antiglobulin tests found on cord blood sampling

Review of positive direct antiglobulin tests found on cord blood sampling

A comparison of morbidity rates attributable to conditions originating in the perinatal period among newborns discharged from United States hospitals, 1989–90 and 1999–2000

Neonatal Hemolytic Jaundice: Morphologic Features of Erythrocytes That Will Help You Diagnose the Underlying Condition

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